- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $9,120.11 / $16,595.87
| Facility | | $1,348.96 | $9,120.11 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $4,786.30 / $9,120.11
| Facility | | $1,995.26 | $4,786.30 | $9,120.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $891.25 / $2,570.40
| Facility | | $851.14 | $891.25 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $831.76 / $1,174.90
| Professional | | $831.76 | $831.76 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $676.08 / $1,122.02
| Facility | | $501.19 | $676.08 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $11,220.18 / $16,982.44
| Facility | | $1,995.26 | $11,220.18 | $16,982.44 |